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Pitcairn~Monroeville Sportsmen's Club
Membership Application

Please print or type information clearly

TYPE OF MEMBERSHIP: (Please circle one)
LIFE ACTIVE ASSOCIATE JUNIOR SPOUSAL

MEMBERSHIP CARD #  Year you join:
Last Name__________________________________ JR/SR____
First Name __________________________________ Middle Initial ___
 E-Mail:  ___________________________________________________________
 PHONE: (        )____________________________ (area code required)
ADDRESS: ________________________________ APT # _____  
CITY: ___________________________________  STATE: ______  ZIP:_______
DATE OF BIRTH: _________________ SEX : M / F MARRIED: Y / N
OCCUPATION: __________________________________________________
EMPLOYER: ______________________________________________________________
CITIZEN OF U.S.A.____________
MEMBER OF NATIONAL RIFLE ASSOCATION: ___________
 INTERESTS (Please circle all that apply):
ARCHERY PISTOL RIFLE CMP/DCM TRAP HABITAT SPORTING CLAYS
PROSPECTIVE MEMBERS WILL BE REQUIRED TO ATTEND ALL  REGULAR MEMBERS GENERAL MEETING HELD ON THE FIRST WEDNESDAY OF EACH MONTH AT 7:00 PM AT THE CLUBHOUSE FOR THE FIRST YEAR OF MEMBERSHIP.

A recent picture of yourself is required for membership

Bring some form of Identification!

New members are also required to attend work parties up to 4hrs a year. A $15 assessment will be made on next years dues if no work parties are performed.

Current Fees are due with application along with a current picture of yourself, please make checks payable to PMSC.

$40.00 (Initiation Fee) Plus  $60.00 (Dues) $15.00 (Spousal) $5.00 Junior (under 18)

Dues run from Jan 1 to Dec 31

Payment made by:

Check#________     Amount:________    Cash _______
This organization is governed by strict By-laws and regulations. Any violation of said rules, regulations or falsifications of this application can cause immediate expulsion from the Pitcairn-Monroeville Sportsmen=s Club Inc. By signing this application, the applicant pledges to obey all said laws and rules, and will not support Anti-gun Legislation: belong to, or support any Anti-Hunting, Fishing, Trapping, or Animal Rights Activists groups.

I understand that I will be on probation for one (1) year.
____________________________________________
Proposed Member's Signature
____________________________________________
Sponsor's Signature

Please send this form with payment And current picture to PMSC to...

Membership Committee Chair

Kenneth E Beck

100 E Bryn Mawr Ct  Apt 118E

Pittsburgh,  Pa  15221

Questions? Contact    kebreb@verizon.net

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